Advancing care policy

Integrated retirement communities can meet the housing, health and care needs of elderly people but are hampered by uncertainties over use class definitions, argues Robin Tetlow.

According to the government's 2006 household projections, almost half of the growth between now and 2026 will be in the 65-plus age group. The future housing and care needs of elderly people will undoubtedly be one of the great challenges of the century.

Earlier this year, prime minister Gordon Brown and junior planning minister Baroness Andrews launched a national strategy for housing in an ageing society (Planning, 29 February, p4). Andrews has subsequently emphasised the challenge that Lifetime Homes, Lifetime Neighbourhoods poses for the creativity of the planning profession, underlining the importance of cross-sector partnerships integrating planning for housing, health, social care and the wider community.

Continuing care retirement communities (CCRCs) are one answer. This evolving concept is rapidly gaining popularity as a direct response to the limitations of traditional sheltered housing and care home models, the increasingly diverse housing and care requirements of older people and current demographic trends. The Department of Health describes CCRCs as "an all-embracing, comprehensive alternative to both sheltered housing and residential care, providing for a whole range of individual needs and circumstances".

Schemes vary significantly in their size and the facilities offered. The age range of residents also varies but most are over 75, especially in established schemes. Successful schemes require at least 50 homes in addition to care capacity providing the necessary services and facilities. The desirability of a landscaped open setting necessitates sites from 2ha in size to 5ha or more.

More than 40 such developments have so far been built across the UK. Provision across the public-private spectrum has involved co-operation between several organisations. Leading developers at the moment include Care Village Group, ExtraCare Charitable Trust, Joseph Rowntree Housing Trust, Retirement Villages Ltd, Richmond Villages and St Monica's Trust. The role of the private sector is increasing.

As well as the national strategy, other government planning policy and practice advice highlight the needs of the elderly. Paragraph 21 of PPS3 requires regional spatial strategies (RSSs) and local development frameworks (LDFs) to have particular regard to "the accommodation requirements of specific groups, in particular families with children, older and disabled people". Paragraph 69 asserts that local planning authorities must have similar regard in deciding applications.

To date, ageing and inclusion policies appear not to be feeding through into either RSSs or LDFs. In approving the East of England Plan in May, the secretary of state ordered an immediate review to allow for more "explicit consideration of the housing needs of an ageing population" among other matters. Community strategies are beginning to prioritise the needs of the elderly, but this tends not to be properly reflected in LDF draft core strategies.

Most strategic housing land availability assessments are fairly basic. This is reflected in LDF site allocation documents, which fail to identify how and where the future needs of elderly people will be met. The DCLG's August 2007 practice guidance on strategic housing market assessment offers advice on including these specific housing requirements in the evidence base. However, it is important to note that this does not encompass care needs, which fall within the remit of social services authorities and primary care trusts.

The site requirements for CCRCs are exacting. Sites allocated as "housing" in development plans have rarely been developed as CCRCs except as part of or in lieu of an affordable housing element. Indeed, most have only proceeded as a result of decision-makers recognising special circumstances or granting permission as an exception to normal development plan policies. Too few councils have done this and some seem unable to grasp the benefits of the concept.

The key policy challenge is that the constituent elements of CCRCs straddle the boundaries between class C2 care facilities and class C3 dwellings. This causes uncertainty as to whether they should count towards overall housing land supply. The interpretation of Use Classes Order definitions has varied according to the particular circumstances of proposals and the range of services and facilities provided.

Occasionally, complications have arisen in defining the overall planning unit, while some early developments did not include all of the key ingredients of CCRCs (see panel). The RTPI Good Practice Note 8 - Extra Care Housing highlights the importance of the care element being recognised via a Commission for Social Care Inspection registered domiciliary care operator or scheme. It goes on to state that "this should clarify whether the development is regarded as a residential institution or a group of 'ordinary' dwellings."

Our experience, backed by counsel's opinion, suggests that true CCRCs constitute an integral whole and should be regarded as falling within class C2, subject to appropriate section 106 controls. Whether or not CCRCs should be required to provide an affordable housing contribution is closely related to the use class issue, although it is sometimes incorporated anyway.

The secretary of state has recognised the potential practical difficulties in making on-site affordable housing provision. In an appeal decision last September (DCS 100-050-263), an inspector determined that no on-site or off-site affordable housing was required for a CCRC development in a Warwickshire village because "as a matter of fact and degree" it would fall into class C2. This was integrally linked to his central conclusion that a moratorium on additional housing operated via development plan policy did not apply to the proposal.

Several ministerial decisions have established that the location of CCRCs in relation to local amenities is less critical than for general market housing. Subject to other planning policy constraints, CCRCs can be developed successfully in relatively rural locations, since day-to-day services can be provided on-site and residents have no need to be near schools and employment sites.

An officer's report on a proposed CCRC on the edge of Sandford considered by North Somerset Council this spring set out the issues clearly. It recognised that the scheme would cater for the needs of the whole district, a more urban location might be more sustainable and such a major development would have a significant impact on the village. However, it concluded that "the community benefits outweigh any uncertainty that may exist by allowing such a large number of care units in a rural location".

A number of CCRC-type developments have been permitted in the green belt. An extra care community - not a full CCRC - near Oldham won approval in February (DCS Number 100-053-105). The secretary of state acknowledged that the proposal amounted to inappropriate development in the green belt but decided that the advantages clearly outweighed the harm and constituted very special circumstances.

CCRCs add to the overall diversity, choice and quality of the housing and care solutions available to our ageing population and deserve to be given more weight by local authorities. The planning profession has a central role to play in bringing more schemes to fruition.

Robin Tetlow is managing director of Tetlow King Planning Ltd. Continuing Care Retirement Communities - A Guide to Planning is available at www.PlanningResource.co.uk/doc

CARE COMMUNITIES

Key features

- A range of accommodation including a care home.

- Provision of personalised domiciliary care services beyond the care home.

- Specialist equipment and 24-hour on-site support for frailer residents.

- A comprehensive range of catering, social, leisure and communal facilities.

- A green travel plan and minibus service.

- Finance through a single entry fee plus a regular service fee.

Key benefits

- Increased choice and quality of specialist accommodation.

- Opportunities for older people to maintain their independence in a secure environment and designed community.

- Flexible care tailored to individual needs.

- Additional facilities potentially available to the wider community.

- Reduced pressure on existing public and private local health services.

- Release of underoccupied family housing into the wider housing market.

- Creation of a significant number of jobs.


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